This study aims to determine the effectiveness of the SIESTA-Rehab protocol compared to usual
care on inpatient sleep and stroke rehabilitation measures.
One inpatient floor will be chosen to receive the SIESTA protocol, while another floor will
continue providing the standard of care. Floors will be asked not to speak about the protocol
with other floors. It is highly unlikely that there would be crossover in personnel between
the two floors and therefore we do not believe contamination will occur. Upon admission,
patients are assigned to one of the two floors based on bed availability. The SIESTA-Rehab
protocol consists of two parts. First, nurses will be educated and empowered to reduce
unnecessary disruptions. This will begin with an informational video on common disruptions
facing inpatients, and then staff will be introduced to techniques to minimize sleep
disruptions such as batching medical tasks, less frequent nighttime visits, dimming lights,
shutting doors, and reducing staff conversation. A SIESTA checklist for staff will also be
utilized and SIESTA-Rehab Posters and Badge Cards will remind staff to practice these
strategies. The Batched Care Protocol will be implemented with routine educational reminders
and nudges for the nursing staff. Second, all patients on the intervention floor will be
screened for sleep-disordered breathing using ApneaLink devices. Based on interpretation from
the research team's sleep specialist, patients will be provided a treatment plan if
necessary. The standard of care floor will serve as a control unit in which nursing care will
continue as usual without any interventions to promote sleep and with routine screening for
sleep disorders based on clinician judgment (current rates of stroke patients receiving a
sleep study are less than 10%).
First aim is to determine subjective measures of sleep quality disruptions, objective
nocturnal sleep disruptions, and objectively-measured sleep including duration, efficiency,
and Wake After Sleep Onset (WASO). These objective and subjective measures will be collected
during the participant's inpatient stay using the Karolinska Sleep Diary, the Modified
Potential Disruptions of Hospital Sleep Questionnaire, electronic chart audit, the
Apnea-Hypopnea Index, the Insomnia Severity Index, and through various wearable sensors.
Additionally, the study aims to determine if there exist differences in traditional measures
of stroke recovery plus novel measures of activity and exercise tolerance using wearable
sensors during inpatient rehabilitation in the SIESTA-Rehab protocol compared to the standard
of care. The investigators will measure various activity outcomes throughout the course of
the inpatient stay and during a 3-month period following discharge from the hospital to
determine whether the SIESTA-Rehab protocol improves activity measures compared to usual
care. These measures include the 6-Minute Walk Test with VO2 analysis, the 10-Meter Walk
Test, the Berg Balance Scale, the Timed Up and Go test, the Manual Muscle Test,
spatiotemporal parameters of gait using the GaitRite system, and the Action Research Arm
Test.
Finally, the aim is to determine the effects of the SIESTA-Rehabilitation protocol on sleep,
physical activity, and functional performance at home for up to 3-months after discharge from
inpatient rehabilitation. Wearable sensors will collect data throughout the home follow-up
period, and physical activity and performance outcomes will be measured at discharge and
again at 1-month, 2-month, and 3-month follow-up visits.